To amend title XIX to the Social Security Act to eliminate the requirement for States to seek recovery of medical assistance properly paid and to restrict the use of liens and such recovery in any MediGrant program and any other future medical assistance programs, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

January 25, 1996

Mr. BRYANT of Texas introduced the following bill; which was referred to the Committee on Commerce

A BILL

To amend title XIX to the Social Security Act to eliminate the requirement for States to seek recovery of medical assistance properly paid and to restrict the use of liens and such recovery in any MediGrant program and any other future medical assistance programs, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Family Farm and Home Protection Act’.

SEC. 2. REVISION OF STATE AUTHORITY IN IMPOSING LIENS AND RECOVERING FOR MEDICAL ASSISTANCE PROPERLY MADE.

(a) ELIMINATING MEDICAID MANDATE FOR STATE RECOVERIES- Subsection (b)(1) of section 1917 of the Social Security Act (42 U.S.C. 1396p) is amended by striking ‘except that’ and all that follows and inserting the following: ‘except--

‘(A) in the case of an individual described in subsection (a)(1)(B), from the individual’s estate or upon sale of the property, subject to a lien imposed on account of medical assistance paid on behalf of such individual, and

‘(B) in the case of any other individual who is 65 years of age or older, when the individual received such assistance, from the individual’s estate.’.

(b) REVISION OF DEFINITION OF ESTATE- Section 1917(b)(4) of such Act (42 U.S.C. 1396p(b)(4)) is amended--

(1) by striking ‘deceased individual’ and all that follows through ‘(A) shall’ and inserting ‘deceased individual shall’, and

(2) by striking subparagraph (B).

(c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to medical assistance furnished on or after the date of the enactment of this Act and the amendments made by subsection (b) shall apply to individuals dying on or after such date of enactment.

(a) IN GENERAL- Notwithstanding any other provision of law, no Federal funds shall be paid to a State under a State medical assistance program (as defined in subsection (d)) unless the conditions of subsections (b) and (c) are met.

(b) LIMITATION ON IMPOSITION OF LIENS-

(1) IN GENERAL- No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State medical assistance program, except--

(A) pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual, or

(B) in the case of the real property of an individual--

(i) who is an inpatient in a nursing facility, intermediate care facility for the mentally retarded, or other medical institution, if such individual is required, as a condition of receiving services in such institution under the State program, to spend for costs of medical care all but a minimal amount of his income required for personal needs, and

(ii) with respect to whom the State determines, after notice and opportunity for a hearing (in accordance with procedures established by the State), that he cannot reasonably be expected to be discharged from the medical institution and to return home,

except as provided in paragraph (2).

(2) ADDITIONAL LIMITATION- No lien may be imposed under paragraph (1)(B) on such individual’s home if--

(A) the spouse of such individual,

(B) such individual’s child who is under age 21 and is blind or disabled as defined in section 1614 of the Social Security Act, or

(C) a sibling of such individual (who has an equity interest in such home and who was residing in such individual’s home for a period of at least one year immediately before the date

of the individual’s admission to the medical institution),

is lawfully residing in such home.

(3) DISSOLUTION OF LIENS- Any lien imposed with respect to an individual pursuant to paragraph (1)(B) shall dissolve upon that individual’s discharge from the medical institution and return home.

(c) LIMITATION ON ADJUSTMENT OR RECOVERY-

(1) IN GENERAL- No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State medical assistance program may be made, except--

(A) in the case of an individual described in subsection (b)(1)(B), from the individual’s estate or upon sale of the property, subject to a lien imposed on account of medical assistance paid on behalf of such individual, and

(B) in the case of any other individual who is 65 years of age or older, when the individual received such assistance, from the individual’s estate.

(2) LIMITATION- Any adjustment or recovery under paragraph (1) may be made only after the death of the individual’s surviving spouse, if any, and only at a time--

(A) when he has no surviving child who is under age 21, or (with respect to States eligible to participate in the State program established under title XVI of the Social Security Act) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1614 of such Act; and

(B) in the case of a lien on an individual’s home under subsection (b)(1)(B), when--

(i) no sibling of the individual (who was residing in the individual’s home for a period of at least one year immediately before the date of the individual’s admission to the medical institution), and

(ii) no son or daughter of the individual (who was residing in the individual’s home for a period of at least two years immediately before the date of the individual’s admission to the medical institution, and who establishes to the satisfaction of the State that he or she provided care to such individual which permitted such individual to reside at home rather than in an institution),

is lawfully residing in such home and has lawfully resided in such home on a continuous basis since the date of the individual’s admission to the medical institution.

(3) PROCEDURES- The State agency responsible for administration of the State medical assistance program shall establish procedures (in accordance with standards specified by the Secretary of Health and Human Services) under which the agency shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship as determined on the basis of criteria established by the Secretary.

(4) ESTATE DEFINED- For purposes of this subsection, the term ‘estate’, with respect to a deceased individual, shall include all real and personal property and other assets included within the individual’s estate, as defined for purposes of State probate law.

(d) DEFINITIONS- In this section:

(1) STATE- The term ‘State’ includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

(2) STATE MEDICAL ASSISTANCE PROGRAM- The term ‘State medical assistance program’ means the MediGrant program (under title XXI of the Social Security Act) or other program of Federal assistance to States for medical assistance expenditures.